Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer

Matsuo, Koji; Machida, Hiroko; Horowitz, Max; Shahzad, Mian M.K.; Guntupalli, Saketh R.; Roman, Lynda D.; Wright, Jason D.

doi:10.1016/j.ajog.2017.06.019

Cited by 20 publications

(17 citation statements)

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“…2 Data sparsity means that the number of observations is very low in the combinations of independent and dependent variables. As indicated by Matsuo et al 1 in Tables 3 and 4, there are not enough events in their study, and data sparsity was expected. Sparse data bias is one of the most important biases that occur in studies with sparse data and makes the measure of association remarkably inflated and the confidence interval considerably wide.…”

Section: To the Editorsmentioning

confidence: 84%

“…We were interested to read the article authored by Matsuo et al 1 that was published in the American Journal of Obstetrics and Gynecology in 2017. The authors conducted research to explore the incidence of and risk factors for metachronous ovarian cancer among young women with stage I cervical cancer who had undergone ovarian conservation at the time of hysterectomy.…”

Section: To the Editorsmentioning

confidence: 99%

“…The authors found that increased metachronous ovarian cancer risk may be related with older age, non-white ethnicity, adenocarcinoma or adenosquamous histology, and adjuvant radiotherapy. 1 However, it seems that there are some methodologic issues that could affect the validity of the results.…”

Section: To the Editorsmentioning

confidence: 99%

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Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer: methodologic issues

Almasi‐Hashiani

Ayubi

Safiri

2018

American Journal of Obstetrics and Gynecology

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Section: To the Editorsmentioning

confidence: 84%

Section: To the Editorsmentioning

confidence: 99%

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Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer: methodologic issues

Almasi‐Hashiani

Ayubi

Safiri

2018

American Journal of Obstetrics and Gynecology

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“…Given the excess risk of secondary malignancy in women with cervical cancer due to various factors such as cigarette and radiotherapy uses, long‐term safety assessment after ovarian conservation is particularly necessary; however, this was not applicable in our retrospective study with relatively short follow‐up (median follow‐up time, ∼5 years). A recent population‐based study has shown that 10‐ and 20‐year cumulative incidences of metachronous ovarian cancer after ovarian conservation for young women with stage I cervical cancer are 0.2 and 0.5%, respectively (median follow‐up time, >10 years) . Because their study did not have a proper control arm from general population to estimate relative risk of ovarian cancer after ovarian conservation for young women with stage I cervical cancer, further study is warranted to assess this long‐term safety issue after ovarian conservation.…”

Section: Discussionmentioning

confidence: 99%

“…A recent population-based study has shown that 10-and 20-year cumulative incidences of metachronous ovarian cancer after ovarian conservation for young women with stage I cervical cancer are 0.2 and 0.5%, respectively (median follow-up time, >10 years). 40 Because their study did not have a proper control arm from general population to estimate relative risk of ovarian cancer after ovarian conservation for young women with stage I cervical cancer, further study is warranted to assess this long-term safety issue after ovarian conservation.…”

Section: Cancer Therapy and Preventionmentioning

confidence: 99%

Identifying a candidate population for ovarian conservation in young women with clinical stage IB–IIB cervical cancer

Matsuo

Shimada

Yamaguchi

et al. 2017

Intl Journal of Cancer

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This study seeks to identify risk factors associated with ovarian metastasis and to characterize a population with minimum risk of ovarian metastasis in young women with stage IB-IIB cervical cancer. This was a nation-wide multicenter retrospective study in Japan examining consecutive cases of surgically-treated women with clinical stage IB-IIB cervical cancer who had oophorectomy at radical hysterectomy (n = 5,697). Multivariable analysis was performed to identify independent risk factors for ovarian metastasis. Ovarian metastasis was seen in 70 (1.2%, 95% confidence interval 0.9-1.5) cases. In the entire cohort, adenocarcinoma, lympho-vascular space invasion, uterine corpus tumor invasion, and pelvic/para-aortic nodal metastases remained independent risk factors for ovarian metastasis (all, adjusted-p< 0.05). In a sensitivity analysis of 3,165 women aged <50 years (ovarian metastasis, 1.0%), adenocarcinoma, parametrial tumor involvement, uterine corpus tumor involvement, and pelvic/para-aortic nodal metastases remained independent risk factors for ovarian metastasis (all, adjusted-P < 0.05). In the absence of these five risk factors (representing 46.1% of women aged <50 years), the incidence of ovarian metastasis was 0.14%. With the presence of adenocarcinoma alone (representing 18.9% of women aged <50 years), the incidence of ovarian metastasis was 0.17% and was not associated with increased risk of ovarian metastasis compared to the subgroup without any risk factors (p = 0.87). In conclusion, nearly two thirds of women aged <50 years with clinical stage IB-IIB cervical cancer had no risk factor for ovarian metastasis or had adenocarcinoma alone: these subgroups had ovarian metastasis rates of around 0.1% and may be a candidate population for ovarian conservation at surgical treatment.

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Matsuo

Roman

Wright

2018

American Journal of Obstetrics and Gynecology

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We appreciate the comments by Almasi-Hashiani et al about our recent work. 1 In our study, the incidence of metachronous ovarian cancer after ovarian conservation for young women with early-stage cervical cancer was examined by the use of a population-based tumor registry in the United States. We found that there were only 13 of 4365 women (0.3%) who experienced the development of metachronous ovarian cancer during the follow-up period. We agree with their concern that the number for metachronous ovarian cancer cases is relatively small to perform detailed analysis of risk factors. Because the primary objective of our study was to examine the incidence of metachronous ovarian cancer after ovarian conservation, we believe that the low incidence of metachronous ovarian cancer that was found in our study is indeed reassuring for care providers and patients when ovarian conservation is discussed in the treatment plan of early-stage cervical cancer. We agree that confidence intervals of the point estimates for the associations of various factors with metachronous ovarian cancer are wide, given the small number of events. Confidence intervals are provided so that readers can understand the degree of uncertainty for the point estimates. We thank Almasi-Hashiani et al for their suggestions for alternative statistical approaches to enrich the methods for the analysis of risk factors that are associated with metachronous ovarian cancer after ovarian conservation. Again, because this was not the primary objective of the study but rather a secondary objective, we respectfully would defer further exploration for additional studies. Proportional hazard assumption in our model was satisfied. Given the frequency of cervical cancer in young women, the possibility of ovarian conservation is of great interest. Clearly, further work to define the risk of metachronous ovarian cancer and risk factors for the development of ovarian lesions is needed. 2

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Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer

Abstract: Metachronous ovarian cancer risk after ovarian conservation for women with stage I cervical cancer is <1%. Older age, non-white ethnicity, adenocarcinoma or adenosquamous histology, and adjuvant radiotherapy may be associated with an increased metachronous ovarian cancer risk.

Cited by 20 publications

References 19 publications

Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer: methodologic issues

Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer: methodologic issues

Identifying a candidate population for ovarian conservation in young women with clinical stage IB–IIB cervical cancer

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